Healthcare Provider Details

I. General information

NPI: 1366912461
Provider Name (Legal Business Name): ADITI C PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48876 WINDMILL CIR E
MACOMB MI
48044-4919
US

IV. Provider business mailing address

48876 WINDMILL CIR E
MACOMB MI
48044-4919
US

V. Phone/Fax

Practice location:
  • Phone: 586-457-7286
  • Fax:
Mailing address:
  • Phone: 586-457-7286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502004386
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: